Death rates have declined, largely due to successes in HIV, but a lot more needs to be done to defeat its “terrible twin”, tuberculosis (TB). This is according to the 20th edition of the South African Health Review published by the Health Systems Trust (HST). The review, published annually, noted that life expectancy which rose from its lowest levels in the mid 2000s, has been maintained. In 2006, due to the explosion in new HIV infections and little access to treatment, life expectancy was 52 years but in 2015 it had risen to over 63 and remains stable. This increase was driven by a massively scaled-up antiretroviral programme: the largest in the world.